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Growth in skin surgery.
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A noninvasive surgical treatment of axillary hyperhidrosis.
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Liposuction surgery and autologous fat transplantation.
Since the importation of liposuction surgery into the United States more than a decade ago, we have witnessed a number of major technique changes and practice trends occur. One of us (L.M.F.) was the first dermatologic surgeon to undergo the "lipsuction experience" (Paris, 1977) under the tutelage of Giorgio and Arpad Fisher and Pierre Fournier, and another (R.S.N.) the first to undergo training with Yves Illouz (also Paris). All three co-workers have served on teaching faculties of both the International and American Societies for Dermatologic Surgery, the American Society of Liposuction Surgery, and the American Academy of Cosmetic Surgery, have performed many hundreds of procedures, and have lectured/published on this subject on repeated occasions. We recognize certain vital changes and expansions have occurred during the past decade, and share our impressions of these with you.
Histological investigation of liposuctioned fat for injection laryngoplasty.
PURPOSE: There are a few injectable biomaterials used in vocal-fold-augmentation surgery. In this study, liposuctioned autologous fat, used as the injection material, was investigated histologically. MATERIALS AND METHODS: Liposuctioned fat, which was harvested from 13 patients during injection laryngoplasty, was examined by light and electron microscopy. RESULTS: The cell membranes of most of the liposuctioned fat had not been damaged during harvesting and microinjection by our method. The harvested liposuctioned fat was a group of unilocular fat cells. Each cell was surrounded by a meshwork of fine reticular fibers. The cells were spherical and about 30 to 130 microm in diameter. The cells size and density were different from individual to individual. The diameters of liposuctioned fat cells were correlated with the body mass index. Dense and small fat cells were able to maintain graft volume. Sparse and large fat cells tended to not be able to maintain graft volume. There was little proliferation of unilocular fat cells, which were not able to maintain graft volume. CONCLUSION: The structure consisting of a unilocular cell, containing a single droplet of lipid, surrounded by a meshwork of delicate reticular fiber is one of the reasons why autologous fat has viscous properties similar to those of human lamina propria. Autologous fat was not damaged by our harvesting and microinjection method. The size, density and proliferation of fat cells, and ground substance around them may be related to resorption and a decrease in surviving graft volume.
[Fat pulmonary embolism after liposuction].
A 24-year-old woman undergoes buttock's liposuction as an outpatient procedure. As she went back home, progressive dyspnea, respiratory distress and collapse developed. At hospital admission, she was dyspneic with thoracic oppression, tachycardia and anguish. Chest X-ray and thoracic CT scan suggested a pulmonary localisation of fat emboli. Symptomatic treatment allowed complete recovery. This report discusses diagnosis of fat emboli after liposuction as well as epidemiology and physiopathology.
[Liposuction and liposculpture].
Liposuction set a watershed in the evolution of plastic and cosmetic surgery, by allowing permanent removal of excess fat localized underneath the skin. Many body areas, once considered as untouchable, are now accessible since liposuction grew superficial and circular. Liposuction, generating skin retraction, made shorter scars feasible in most cosmetic surgery procedures, and opened up the way to liposculpture of the face and the body. Constantly improving therapeutic means have been succeeding one another: use of sharp followed by blunt cannula, laser/ultrasound-assisted liposuction, as well as rotary and vibrating cannula: what will remain in a few years em leader ? It is today taken for granted, that liposuction, now becoming sculptured, cannot be ignored anymore, and numerous ongoing research studies ensure that it still has a long life ahead.
[Outline surgery after massive weight lossing or gastroplasty].
The silhouette surgery in case of obesity or after gastroplasty and massive weight loss is near the usual outline surgery. However, many differences shall be well-known: more and more cases appear and demand is rapidly growing. The main demand for surgery is aesthetical improvement. The development of gastroplasty has greatly increased the demand of this outline surgery. At the beginning of gastroplasty, plastic surgeons sent pathological obeses to the first "gastroplastician" visceral surgeons. Now, after massive weight loss (over 60 kg), general health is improved, but aesthetical aspect is often worsened; so the patients turn back to the plastic surgeons. The therapeutical program associated combined surgeries, for example: breast plasty and abdominoplasty performed during the same procedure or important and multilocular lipoaspirations. Large skin excess and persisting over weight influence surgical procedure. A strict preoperative planning is mandatory to obtain safe, quick and satisfying result. Preoperative informations concerning results and postoperative evolution (like, for example, the possibility of blood transfusion, infection and scars em leader ) are very important. Usually, five procedures will be necessary over a 3 or 4-years period of time: abdominoplasty, body-lifting, arm and thigh-lifting, breast surgery for ptosis, hyper- or hypotrophia of the chest, lipoaspirations and, in a few cases, face lifting em leader. We describe this so particular outline surgery, its techniques and usual evolution.
[The face lifting].
The authors wanted to evoke the main steps of the "star" operation that is the face lifting. They also wanted to recall what had been done, what is being done and what has passed off. They also wanted to toss out some ideas concerning the future, knowing of course that it is unpredictable.
[Volume and facial rejuvenation].
The request of care for facial aging has changed. Patients wish more and more a "natural" rejuvenation. The analysis of the different ways of aging shows that it is important to restore the mid-face volumes in order to obtain the fullness of youth. Numerous techniques have been used to increase the central volumes. After an historical study of the different methods, the authors present the new concepts that give a large place to lipostructure as described by Coleman. This technique can be used alone or in association with other techniques (lifting, collagen or other products injections...). The results are motivating; the process is simple and quick. The post-surgical oedemas are often important, but complications are exceptional. All these criteria correspond to current demands linked to aesthetic surgery considering medico-legal pressure. The future is based on the improvement of good grafts defining more precisely the factors of resorption of adipose graft tissues.
[High frequency ultrasonography and celluscore: an improvement in the objective evaluation of cellulite phenomenon].
As they usually do not have any serious effect on health condition, cellulite phenomenons are not considered as potentially hazardous by general practitioners; unfortunately they involve almost all the feminine population after the forties and may really induce bad side effects either psychological or physical whatever the confusing origin of that cutaneous deformation: heredity, nutrition, circulatory and hormonal diseases etc. Trying to appreciate in a more scientific way this superficial skin disorder, we have developed a computerised questionnaire which can be combined with the finest upto date way of skin exploration, high frequency ultrasonography. It seems possible to consider now cellulite as the result of various disorders which can be separate into fibrotic or retentional phenomenons (surrounding superficial fat tissues) and the direct adipocyte reaction (adiposis). We hope to be able in the future to extend the treatment of cellulite beyond the limits of liposuction which seems until today the only way to bring some improvement to that phenomenon in spite of the very delicacy of the surgical approach.
[Fat tissue graft or Lipostructure].
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[Abdominoplasty after twin pregnancy: study of 30 cases].
INTRODUCTION: Compared to single mother-hood, the twin pregnancy results in important esthetic and functional sequelae of the abdominal wall. The considerable uterine growth involves a musculocutaneous diastasis of both the supra-umbilical and the infra-umbilical area. This study presents the modified abdominoplasty technique with an inverted T scar as the appropriate treatment of supra-umbilical and infra-umbilical musculocutaneous defects. METHODS AND MATERIALS: This series reviews a total of 30 female patients of 35 years on average. There was no cases obesity or smoking reported. Surgical treatment consisted in a skin and fat resection following an inverted T scar design and associated to a muscle plication. In 6 patients it has been necessary to repeat the procedure in 6 months time. RESULTS: All 30 patients resolved with an aesthetic and functional improvement. No instances of abdominal diastasis recidivation occurred. There were no complication observed and no impact on the healing process was referred. CONCLUSION: on of the main differences between single and twin pregnancies is that the second ones are concerned by an abdominal diastasis marked on both a vertical and a transversal direction. The complete surgical treatment sometimes includes a second intervention. Clinical results and luck of complications suggest that the T-type abdominoplasty associated to a muscle re-tightening offers an appropriate surgical treatment of patients concerned.
[Sequelae of haemangiomas: surgical treatment].
The cure without after-effect of an hemangioma is classic but sometimes the spontaneous involution, a premature surgical treatment or an evolutionary complication can be at the origin of a definitive after-effect. In these cases, the treatment of the hemangioma, often multidisciplinary, will be begun in a late way during the late childhood or the adolescence. Surgical excision of an excess tissue or of a wide scar, lipoaspiration of a fat remainder, lasertherapy and fat tissue reinjection are simple and mostly sufficient procedures. In the most complex cases, notably at the facial site, a surgery heavier as a rhinoplasty, a resection of lip, a local flap or orthognatic surgery can be necessary.
Adipogenic differentiation of adipose tissue derived adult stem cells in nude mouse.
We evaluated the use of a combination of adipose tissue derived adult stem cells (ADSCs) obtained from liposuction and injectable poly(lactic-co-glycolic acid) (PLGA) spheres for adipose tissue engineering. Adipogenesis was examined in nude mice injected subcutaneously with ADSCs (group I), PLGA spheres (group II), or ADSCs attached PLGA spheres (group III) cultured in adipogenic medium for 7 days. After 4 and 8 weeks, newly formed adipose tissue was observed in groups II and III but not in group I. Oil red O staining of newly formed tissue showed that there was substantially more tissue regeneration and adipogenic differentiation in group III than in group II. RT-PCR confirmed that, after 8 weeks, the PLGA-attached ADSCs had fully differentiated into adipocytes. This study provides significant evidence that ADSCs and PLGA spheres can be used in a clinical setting to generate adipose tissue as a noninvasive soft tissue filler.
Plication of the platysma.
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Effect of liposuction on insulin resistance and vascular inflammatory markers in obese women.
Liposuction is one of the more common elective surgical procedures in the US and is supposed to be on the increase. There are no reported studies specifically addressing the metabolic sequelae of liposuction in obesity. The aim of the present study was to investigate the role of large-volume liposuction on insulin resistance and circulating inflammatory markers in obese people. Thirty healthy premenopausal obese (body mass index (BMI) from 30 to 45) and 30 age-matched normal weight (BMI<25) women were studied. In obese women, insulin sensitivity, as measured by the Homeostasis Model Assessment (HOMA=fasting plasma glucose x fasting serum insulin divided by 25), as well as serum adiponectin, the novel adipocytokine with insulin sensitising properties, were significantly lower, as compared with nonobese women (p<0.01), indicating insulin resistance; on the contrary, serum concentrations of the proinflammatory cytokines IL-6, IL-18 and TNF-alpha, as well as the sensitive marker of inflammation C-reactive protein, were significantly higher (p<0.01). All obese women were submitted to a single large volume liposuction (superwet technique): the mean aspirate volume was 3540 ml (range 2550-4670), corresponding to a net lipid loss of 2.7+/-0.7 kg (mean+/-SD). After six months of stable body weight after liposuction, women were less insulin resistant (p<0.05), had reduced concentrations of IL-6, IL-18, TNF-alpha and CRP (p<0.05-0.02), and increased serum levels of adiponectin (p<0.02) and HDL-cholesterol (p<0.05). There was a significant correlation between the amount of fat aspirate and changes in HOMA (r=0.28, p<0.05), TNF-alpha (r=0.31, p<0.02), and adiponectin (r=-0.34, p<0.02), as well as between the decrease in TNF-alpha and the increase in adiponectin after the surgical procedure (r=-0.45, p<0.01). Our study demonstrates that liposuction is safe and free of metabolic sequelae in obese women, pending a careful screening of the patient. Moreover, it is associated with amelioration of insulin resistance and reduced circulating markers of vascular inflammation which may help obese subjects to reduce their cardiovascular risk.